RT Journal Article SR Electronic T1 Cerebroprotection in the endovascular era: an update JF Journal of Neurology, Neurosurgery & Psychiatry JO J Neurol Neurosurg Psychiatry FD BMJ Publishing Group Ltd SP 267 OP 271 DO 10.1136/jnnp-2022-330379 VO 94 IS 4 A1 Schneider, Anna M A1 Regenhardt, Robert W A1 Dmytriw, Adam A A1 Patel, Aman B A1 Hirsch, Joshua Adam A1 Buchan, Alastair M YR 2023 UL http://jnnp.bmj.com/content/94/4/267.abstract AB Despite advances in clinical diagnosis and increasing numbers of patients eligible for revascularisation, ischaemic stroke remains a significant public health concern accounting for 3.3 million deaths annually. In addition to recanalisation therapy, patient outcomes could be improved through cerebroprotection, but all translational attempts have remained unsuccessful. In this narrative review, we discuss potential reasons for those failures. We then outline the diverse, multicellular effects of ischaemic stroke and the complex temporal sequences of the pathophysiological cascade during and following ischaemia, reperfusion, and recovery. This evidence is linked with findings from prior cerebroprotective trials and interpreted for the modern endovascular era. Future cerebroprotective agents that are multimodal and multicellular, promoting cellular and metabolic health to different targets at time points that are most responsive to treatment, might prove more successful.